Infection Prevention and Control: Baseline Knowledge and Practices of TBAs in Rural Kano, Northwestern Nigeria

BACKGROUND

Maternal infections remain a significant contributor to maternal mortality worldwide. Majority of births in northern Nigeria occur at home and are attended by Traditional Birth Attendants (TBAs). Little has been documented about their knowledge and practice on infection prevention and control practices in Kano, northern Nigeria.

OBJECTIVES

This study evaluated the level as well as factors associated with TBAs' infection prevention and control knowledge and practices.

METHODS

The study is the baseline phase of a quasi-experimental study, conducted in a rural LGA in Kano State, Nigeria. Using an adapted tool, 163 eligible TBAs were surveyed. Knowledge and practice of IPC were scored, aggregated, and dichotomized into good or poor. Binary logistic regression analysis was used to predict knowledge and practice of IPC.

RESULTS

Majority (79.1%) of the TBAs exhibited poor IPC knowledge but many (78.5%) reported good practice. Good knowledge of IPC was predicted by the TBAs' age: a six-fold increased likelihood (AOR=6.25, 95% CI: 1.02- 38.53) and almost five-fold increased likelihood (AOR=4.75, 95% CI: 1.39- 16.24) for those in their second and fourth decades of life. TBAs who reported poor practice of IPC were 83% less likely (AOR=0.17, 95% CI: 0.03- 0.92) to have good knowledge of IPC. TBAs' practice was only linked to previous training (AOR=0.17, 95% CI: 0.04- 0.76).

CONCLUSION

TBAs knowledge of IPC was low although reported practice was good. The need for tailored training interventions to enhance knowledge and skills for safe delivery care is paramount to improve maternal and neonatal outcomes.

Ruptured Tubal Gestation: An Unusual Presentation of Schistosoma Haematobium Infection of the Fallopian Tube

An unusual mode of presentation of schistosomiasis in the form of a ruptured tubal pregnancy in a previously asymptomatic 23-year-old woman is described. Histological examination of the salpingectomy specimens demonstrated Schistosoma haematobium ova.

Perception of infertility and acceptability of assisted reproduction technology in northern Nigeria

BACKGROUND

Infertility is a stigmatized reproductive morbidity with severe psycho-social consequences, especially in developing countries. There has been little exploration of the public view of infertility and acceptance of assisted reproduction in these countries, including Nigeria.

OBJECTIVE

To determine the public perception of infertility, its causes and factors associated with acceptability of Assisted Reproductive Technologies (ART) in Kano, Northern Nigeria.

METHOD

Using interviewer administered questionnaires, a cross-section of 600 adults were interviewed about perceived definition, causes and acceptance of ART.

RESULT

Majority of the respondents (n = 577, 99.3%) perceived infertility as a disease. Only 18.1% (n = 105) of the respondents would consider a couple infertile after one year of marriage. Causes of infertility mentioned by participants included paranormal events (n = 535, 92.1%), suprapubic pain (n = 321, 55.2%), induced abortion (n = 187, 32.2%) and sexually transmitted infections (n = 177, 30.5%). A minority of respondents (n = 161,27.7%) of participants mentioned blocked tubes and 24.6% (n = 143) irregular menstrual cycles. Although 36.1% of respondents were aware of ART; only 7.6% were willing to accept it. Being male [adjusted odds ratio (AOR) (95% CI)] 2.1 (1.55.72), childless [AOR (95% CI)] 2.2 (1.35.95), highly educated [AOR (95% CI)] 3.2 (1.326.72) and non-Muslim [AOR (95% CI)] 2.3 (1.23.76) were significant predictors of acceptance ofART.

CONCLUSION

Infertility was correctly perceived as a disease, but there were misconceptions about its causes. The low acceptance of ART was influenced by socio-demographic factors. There is a need for sustained targeted information, education and communication regarding new reproductive technologies for fertility management.

Predictors of female genital cutting among university students in northern Nigeria

Female genital cutting (FGC) is a harmful cultural practice that is perpetrated against women and children. Little is known about the extent of this custom among university students in northern Nigeria. Using self-administered questionnaires, we studied the prevalence and determinants of FGC among female university students in Kano, Nigeria (n =359). The prevalence of FGC was 12.1% (95% confidence interval =8.8-15.8%). Awareness and disapproval of FGC among the study population was very high (96% and 91%, respectively). In multivariate regression models, ethnicity and geographic origin were significant predictors of female circumcision. A comprehensive legal and educational framework and the support of civil society, governments and development partners is required to address this form of gender discrimination.

Premarital sexual experience and preferred sources of reproductive health information among young men in Kumbotso, northern Nigeria

BACKGROUND

Despite well known risks associated with unprotected premarital sex, this phenomenon has not been well explored among young men in rural northern Nigeria. We studied the predictors of premarital sex and preferred sources of sexual and reproductive health information among young unmarried men in Kumbotso, northern Nigeria.

METHOD

A cross section of 400 young men were interviewed using structured questionnaires with mostly closed ended questions.

RESULTS

Of the 385 respondents, 39 (10.1%) were sexually experienced. Less than half of respondents (48.7%) used a condom at sexual debut, and an equal proportion reported having multiple sex partners. Only 41.0% of sexually experienced respondents reported subsequent consistent condom use Age (adjusted odds ratio [AOR] = 4.12; 95% confidence interval (CI): 2.24-5.20 and educational attainment [AOR = 3.57; 95% CI (1.49-9.10)] were significant predictors of sexual experience. The current versus preferred sources of sexual and reproductive health information included friends (51.3% vs. 93.3%), Islamic school teachers (41.0% vs. 72.7%) and school teachers (8.8% vs. 15.1%).

CONCLUSION

Although the prevalence of premarital sex among young men in this community in northern Nigeria as low, those that did engage in such activity were likely to not use condoms and to have multiple partners. Preferred and trusted sources of information included peers and religious leaders. The findings in this study could be used to develop innovative strategies for reaching young men with accurate sexual and reproductive health information.

Socio-demographic and maternal factors in anaemia in pregnancy at booking in Kano, northern Nigeria

Anaemia in pregnancy still causes significant maternal morbidity and mortality in the developing countries including Nigeria. The burden and underlying factors are varied even within countries. We studied the prevalence of anaemia at booking and underlying factors in a teaching hospital in northern Nigeria. Using the capillary technique and blood film, the packed cell volume (PCV) and red cell morphology of 300 pregnant women was determined. Additional information was obtained on sociodemographic characteristics, obstetric and past medical history using an interviewer administered questionnaire. Of the 300 pregnant women studied, 51 (17%) [95% Confidence Interval (CI)=12.9%-21.7%] were anaemic. Specifically, 12.7% and 4.3% of the women had mild and moderate anaemia respectively. Blood film of 74.5%, 15.7% and 11.8% anaemic women showed normochromic normocytic, haemolytic and microcytic hypochromic pictures respectively. Low educational attainment [Adjusted Odds Ratio (AOR)=2.13], being single or divorced [AOR=2.02], high parity [AOR=2.06], late booking [AOR=2.71] and short intervals between pregnancies [AOR=2.37] were significant predictors of anaemia in pregnancy. The high prevalence of anaemia in pregnancy related to low educational and economic status especially among women with background obstetric risk factors calls for vigilance, sustained health education and chemoprophylaxis for pregnant women.

A report of three consecutive pregnancies in a kidney transplant recipient and the challenges in their management in a poor resource setting

Kidney transplant recipients (KTR) have a good outcome of pregnancies. However the mother and the child are increasingly at higher risks of complications compared to the general population. The management of these pregnancies is associated with greater challenges and is better if managed by both the obstetrician and the transplant physician. Kidney transplant is available in few centres in Nigeria and the post transplant population is increasing, but to our knowledge no report on pregnancy management in KTR has been published. We present a 25 years old Nigerian who had a live related kidney transplant and later had 3 consecutive pregnancies and review the relevant literature. She was placed on oral contraceptive pills for 2 years after transplantation. She enjoyed a stable allograft function with no rejection episode, no proteinuria, had a good blood pressure control and pelvic ultrasound scan was essentially normal. She conceived her first pregnancy 26 months post transplant however she developed spontaneous abortion at 3 months gestation. She conceived her second pregnancy 33 months post transplant which was supervised by the obstetrician and the transplant physician. She had complications including urinary tract infection, anaemia and dyslipidaemia and delivered a live baby girl weighing 2.4 Kg by spontaneous vaginal delivery at 36 weeks gestation. She conceived her 3rd pregnancy 8 months later which was also carried to term and had a vaginal delivery of a live baby girl weighing 2.55 kg. This report highlights the successful management of pregnancies in KTR and the challenges faced in a poor resource setting.

HIV exposed infants: a preliminary report of the Aminu Kano Teaching Hospital experience

To determine the Sociodemographic characteristics, infant feeding choices and outcome of HIV exposed neonates attending the paediatric infectious disease clinic (IDC) of Aminu Kano Teaching Hospital Kano.

PATIENTS AND METHODS

The records of all HIV exposed babies were reviewed. One hundred and ninety HIV exposed babies were seen between October 2003-December 2005. Of these 121 were part of the PMTCT programme while 69 were not. A total of 179(94.2%) babies were delivered at term while 11(5.8%) were delivered prematurely, with M: F ratio of 1.2:1.

RESULTS

A substantial number of mothers in the non PMTCT group were diagnosed antenataly or even prior to conception yet they did not avail themselves of the interventions in the PMTCT programme. Reasons given were ignorance, inaccessibility to PMTCT centres and fear of stigmatisation. Breast milk substitute, was the leading choice of mothers in the PMTCT group while breast milk and mixed feeding was practised more in the non-PMTCT group.

CONCLUSION

PMTCT remains the best way of preventing paediatric HIV infection and infant feeding counselling should be family oriented. Provision of free infant formula, PCR machines to enable early diagnosis, waiving of fees, and home visits would greatly improve infant follow up.

Maternal health in Northern Nigeria-a far cry from ideal

OBJECTIVE

To determine the level of maternal care in Northern Nigeria.

DESIGN

A cross-sectional descriptive study design was used.

SETTING

The Study was Community based and carried out in the ten states that constitute UNICEF D zone in northeast Nigeria.

POPULATION

Women who delivered in the 11 months preceding the survey and resident in the study area.

METHODS

The WHO cluster sampling methodology was used to draw a sample of 210 eligible women in each of the 10 local government areas (LGAs).

MAIN OUTCOME MEASURES

Utilization of antenatal care (ANC) services, tetanous toxoid immunization, skilled attendant at delivery and postnatal care.

RESULTS

Majority of the respondents, 73.2%, were between the ages 20 and 34 years. Overall, 50% of the women attended antenatal clinics during their last pregnancy, with a range of ANC coverage by LGA of 14.0-81.0%. The proportion of women who booked in the first, second and third trimesters was 22.8, 63.0 and 14.2%, respectively. The antenatal services offered ranged from 95.7% for abdominal examination to 41.2% for urine examination. Sixty percent of the women received no tetanus toxoid in their last pregnancy, 11% had one dose and 29% had at least two doses. Home delivery was still the norm throughout the zone with 1791 (85.3%) delivering at home. Up to 80.5% of the deliveries were supervised by personnel with no verifiable training in sanitary birthing techniques. Only 11.4% (233) of those who received ANC had postnatal check-up.

CONCLUSIONS

Maternal health care as evidenced above is far from the ideal. Likewise, the commitment of the 5th Millennium Development Goal is extremely far-reaching: to reduce the maternal mortality ratio by 75% by the year 2015 with this level of maternal care.

Postpartum beliefs and practices in Danbare village, Northern Nigeria

Postpartum cultural beliefs and practices are widely prevalent in northern Nigeria. Using a cross-sectional survey, we set out to examine contemporary postpartum beliefs and practices among a cohort of 300 mothers in Danbare village, northern Nigeria. Common postpartum practices included sexual abstinence (100%), physical confinement (88%), hot ritual baths (86%), nursing in heated rooms (84%) and ingestion of gruel enriched with local salt (83%). The majority of mothers (93%) believed that these practices made them stronger and helped them regain their physiologic state. Most respondents believed that non-observance could lead to body swelling, foul-smelling lochia and perineal pain. Mothers with formal education were significantly more likely to believe that these practices were non-beneficial compared with those mothers without formal education (odds ratio (OR) = 9.9, 95% confidence interval (CI) = 3.6 - 28.8). Almost half of the respondents (49%) said they would continue with these practices. In conclusion, women are still holding on to postpartum cultural beliefs and practices in northern Nigeria. However, educated women could act as useful agents of change towards the elimination of practices harmful to the health of mothers and their children.

Awareness and attitude of antenatal clients towards HIV voluntary counselling and testing in Aminu Kano Teaching Hospital, Kano, Nigeria

BACKGROUND

Mother to child transmission accounts for the majority of HIV infections in children in the developing countries. This study assessed pregnant women's knowledge of HIV/AIDS, awareness and attitudes towards Voluntary Counselling and Testing (VCT) in a teaching hospital in northern Nigeria.

METHODS

A pre-tested structured interview questionnaire was administered on a cross-section of 210 antenatal clients in Aminu Kano Teaching Hospital, Nigeria.

RESULTS

All respondents were aware of HIV/AIDS. Fifty seven percent had good knowledge, 32% had fair knowledge and the remaining 11% had poor knowledge of the infection. Most respondents were aware of VCT through health workers, mass media and friends. Similarly, most respondents (81.0%) approved of VCT, 13.0% disapproved of it and the remaining (6%) was undecided. The main reasons for disapproval were; fear of stigmatisation, isolation and effect on marriage security. Those that had tertiary level of education were three times more likely to accept VCT compared to those with lower levels of education (O.R=3.2, 95% confidence interval =1.3-8.0).

CONCLUSIONS

Although the awareness of VCT for HIV was quite high with most antenatal clients harbouring positive attitudes towards it, there is a need to intensify health education to convince the remaining minority who are still sceptical or ignorant of the benefits of VCT.

Prevalence of trichomonas vaginalis in patients with vaginal discharge in Lagos, Nigeria

Trichomonas vaginalis is the most prevalent, non-viral sexually transmitted infection worldwide and probably the most commonly treatable in Africa and worldwide. The purpose of this study was to determine the prevalence of T. vaginalis among women with vaginal discharge attending a gynaecologic clinic in Lagos and to identify the common characteristics of the vaginal discharge in T Vaginalis. High vaginal swabs were taken from consenting adults with vaginal discharge. The quantity, colour and odour of the discharge were noted. Amine (10% KOH) test and pH were determined. Wet-mount microscopy Giemsa staining and culture in Oxoid (R) Trichomonas Medium were performed on each swab. A total of 200 patients were examined. One hundred and forty-nine (74.5%) had T. vaginalis. There was no statistically significant association between age, marital status, parity, number of sexual partners and prevalence of T vaginalis. The colour of the discharge was white in 104 (69.8%), yellow in 30 (20.1), clear in 15 (10.1%). None was frothy or greenish. The discharge was heavy in 50 (33.6%) and malodorous in 51 (34.2%). The pH range was 4-7 and 42 (28.2%) normal pH of4. In 47 (31.5%) the amine test was negative. The prevalence of T vaginalis among women with vaginal discharge is high. Women complaining of vaginal discharge should be thoroughly screened for T. vaginalis using all available methods.